Provider Demographics
NPI:1427272301
Name:GERMAN, TINA L (DDS)
Entity type:Individual
Prefix:DR
First Name:TINA
Middle Name:L
Last Name:GERMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2324 S CLOVER LN
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46580-6416
Mailing Address - Country:US
Mailing Address - Phone:574-269-2166
Mailing Address - Fax:574-269-3506
Practice Address - Street 1:1603 N DETROIT ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46580-2273
Practice Address - Country:US
Practice Address - Phone:574-269-7377
Practice Address - Fax:574-269-3506
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010830A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice